Amy Pare is a plastic surgeon in Washington County. She makes her living doing lifts, tucks and augmentations. So it’s remarkable that she finds herself in the middle of a public health debate.

It started about two years ago, she said. That’s when patients started coming in with what looked like acne on their faces.

“We started to have patients that would have open areas or recalcitrant lesions, that just kind of bled, ulcerated, didn’t quite heal.”

Pare’s first concern was skin cancer. So she took biopsies. They came back negative for cancer. But they weren’t normal either, so she ordered urine tests.
The patients also had headaches and were lethargic.

“We thought, ‘Well, are these patients exposed to anything?’ So then we would ask the patients."

Many of the patients lived near newly-drilled gas wells. When Pare's patients took urine tests, they found methane and toluene, which could have come from exposure to natural gas drilling.

Doctors like Pare are scrambling to figure out how to treat patients like these--and to determine whether there is indeed a link to drilling.

The Pennsylvania Medical Society represents 18,000 doctors in the state. The group thinks fracking could have public health impacts. But, the scientific evidence of such impact is pretty thin, according to Ralph Schmeltz, past president of the Pennsylvania Medical Society.

“There’s a lot we don’t know, and a lot we need to learn about,” said Schmeltz, a University of Pittsburgh endocrinologist.

The shale drilling industry says fracking is safe and points to government reports in Texas and Pennsylvania that found no evidence of groundwater pollution from fracking.

Although a growing number of case studies have documented that people near gas wells are getting sick, those studies are hardly definitive, said Jean Finkel, an epidemiologist at Weill Cornell Medical College in New York.

"We simply don't know what causes many of these reported problems," Finkel said. A headache could come from toxic fumes, but it could just as easily come from stress. To answer the question, scientists need long term studies, she said.

“We have to look at biological plausibility -- is the disease biologically plausible based on the compounds in the drilling process -- and how strong is the association between exposure to risk and development of disease?”

Need for a registry?

Public health professionals are calling for the creation of a health registry for Marcellus shale that would list people who say they’ve gotten sick from fracking.
The idea was championed by Eli Avila, then-Pennsylvania secretary of health, last summer. He made the pitch in June, before the Governor’s Marcellus Shale Advisory Commission. Avila has since resigned.

“The most timely and important initiative that the department can undertake is the creation of a population-based health registry,” he told the commission.

And the state legislature signaled it would help. State lawmakers alotted $2 million from the proposed Marcellus Shale impact fee last year for a health registry. But that money was cut from the bill before it came to a vote. The impact fee passed, without money for a health registry.

Republican State Senator Joe Scarnati, who steered the bill to passage in February, said he was “not a fan” of the registry. Instead, he favored giving money for water testing by the PA Department of Environmental Protection.

Crompton said “there was a lot of uneasiness” among Republican legislators about the public health study “being all spelled out” in the legislation.

“It’s very sensitive when talking about peoples’ health. What types of studies were they going to do? We didn’t want additional burdens placed on our constituents,” said Crompton.

“This has to be very slowly developed. We think Marcellus shale drilling is almost entirely safe,” he said. “We don’t want to stir up any fears.”

Crompton said a public health registry “has to be carefully messaged” because of what he characterized as misinformation about the safety of hydraulic fracturing. “The last thing we need is to propel this (mis)information,” he said.

"Anyone trained in epidemiology will tell you why it is so crucial to have a registry, it’s basic epidemiology," Avila told The Allegheny Front in November, several months after he left the state government.

"It's the only way for some statistical accuracy. You try to educate those in leadership who don’t know about it. But it’s their decision how those laws are written – it’s not my decision. I made my recommendation—my recommendation wasn’t heeded."

The Department of Health said it was consulting with several schools of public health and hospital systems that have recently started conducting shale-related health studies. Senate leader Joe Scarnati has proposed a shale gas health advisory panel, which would include physicians, scientists--and members of the gas industry.

Patients near gas wells

Raina Rippel runs the project in McMurray, Washington County. It’s funded by philanthropies, including The Heinz Endowments, which also supports the operations of The Allegheny Front.

The office isn’t much to look at--just a few plants and a TV in the waiting room.

The medical outreach project is the first of its kind--specifically designed to treat people near gas wells. Rippel says her team will compile patient information for scientists to study, but the project’s primary function is to get help to those who are sick.

“We’re going to the people who we believe have probably been impacted,” says Rippel. “Are these people near a drilling site or gas drilling activities? And are they experiencing significant health concerns? And we want to provide them with a response.”

Among its first clients is June Chappel. She leased her Hopewell Township land for drilling to Range Resources.

Chappel says a frack pond built by Range behind her house produced intense odors. Water in these ponds can contain chemicals used to break up the shale, plus heavy metals and salts from underground.

“It smelled like you were sitting inside your car with a gas can,” Chappel said.

At the time, Chappel’s husband, Dave, was suffering from terminal cancer. He began to develop nosebleeds. She thought they were from his chemotherapy. Then she started getting nosebleeds, too. Then, a ringing in her ears. She said it feels like she’s been to a loud concert the day before, "only this just never stops."

Chappel complained to Range Resources and it removed the frack pond. In an interview with The Allegheny Front, Range spokesman Matt Pitzarella said the company probably shouldn’t have put the impoundment so close to Chappel’s house, mainly because of the truck traffic.

However, he said any odors were probably due to bacteria, not pollution. And he disputed the idea that the wells could have made Chappel sick. Pitzarella cited an MIT study which found only 43 health or environmental problems out of 20,000 shale gas wells drilled over the last 10 years.

Chappel is still worried about the long-term impact of her exposure to the frack pond.

Despite complaints like these, some are convinced fracking is safe.

Dr. Sean Porbin, for example, sees more benefit than risk from fracking. He has a small practice in Avella. The town is surrounded by wells.

“I’ve been looking for the past three years and I haven’t seen a thing. I think the big story here is ... with all the hype, there is no story,” Porbin said.

Porbin himself has leased gas rights to his property. He sees the gas rush as a boon to the old coal town. And he wonders if health complaints aren’t driven by a profit motive. Still, he said, he’ll keep his eyes open and he’s signed on to work with the newly-opened environmental health center.

“The potential here is that everyone is supposed to win,” he said. “The farmer’s getting the royalties, the Subway shops that are full at lunch, the little gas station. Everyone’s winning here. And no one wants to see anyone get sick. You got to watch it, though. And we are.”

Among those who count themselves as winners are Kathy and Guy Avolio. Chesapeake Energy drilled a well on their property three years ago. It sits on a large pad behind their home. The couple lives on a 600-acre farm in Avella with a koi pond and a chicken coop. Kathy Avolio said her three kids have a nickname for the well: College.

Guy Avolio is an urgent care physician. He’s heard and read reports of water contamination from fracking. But he’s convinced that drilling is the right thing to do and so is his wife.

“I would never put my kids -- no matter what price tag you put on it -- would I ever put my kids in harm’s way,” said Kathy Avolio. “But I also feel like my husband does -- we have to try, to get this. I mean, this is an incredible technology.”

The Avolios grew up near Pittsburgh and remember when the steel mills were booming. That memory colors how they think about the current gas boom.

“My dad was a steelworker in Aliquippa. He always says, ‘You know, the cars were dirty, the streets were dirty, but at least everybody had a job.’”

In their backyard and in their town, the Avolios see economic prosperity. And their family is healthy. For the Avolios, the benefits of shale outweigh the risks.